Effects of maternal age, parity and pre-pregnancy body mass index on the glucose challenge test and gestational diabetes mellitus.

OBJECTIVES: To study the effects of age, parity and body mass index (BMI) on the incidence of a positive 50 g glucose challenge test (OGCT) and gestational diabetes mellitus (GDM) in healthy pregnant Omani women. METHODS: A 50 g OGCT was performed on 307 healthy pregnant Omani women at 24-28 weeks of gestation. When the venous plasma glucose concentration (VPG) reached >7.8 mmol/l after 1 h, the OGCT was considered to be positive. Women with positive OGCTs had a confirmatory diagnosis of GDM, which was established by performing a 2-h 75 g oral glucose tolerance test (OGTT). When either fasting or post-2-h 75 g OGTT values were >5.5 mmol/l or >8 mmol/l, respectively, women were considered diabetic. RESULTS: This study screened 307 women and identified 83 (27.03%) OGCT-positive and 23 (7.5%) GDM-positive cases. The incidences of a positive OGCT and GDM increased significantly with increasing maternal age from 20.0% to 2.2%, respectively, in women aged ≤25 years to 37.8% and 14.7%, respectively, in women aged >35 years (p = 0.02 and p = 0.009, respectively). The incidences of a positive OGCT and GDM increased markedly with increasing pre-pregnancy BMI, from 19.8% to 3.8%, respectively, in women with BMIs ≤25 kg/m2 to 37.8% and 9.9%, respectively, in women with BMIs >25 kg/m2 (p = 0.02 and p = 0.04, respectively). CONCLUSION: Maternal age and pre-pregnancy BMI have profound effects on the incidences of a positive OGCT and GDM.

50 Grams Oral Glucose Challenge Test: Is It an Effective Screening Test for Gestational Diabetes Mellitus?

AIM: To find out whether 50 g oral glucose challenge test (OGCT) is an effective screening test for all pregnant women between 24 and 28 weeks gestation. METHOD: A 50 g OGCT test was administered to 307 unselected women at 24-28 weeks of gestation. When venous plasma glucose (VPG) concentration after 1 h was >7.8 mmol/l, OGCT was positive. Women with a positive OGCT underwent 2 h 75 grams oral glucose tolerance test (OGTT) as a confirmatory diagnosis of GDM. When fasting and 2 h post 75 g OGTT values were >5.5 mmol/I and >8 mmol/l, respectively, women were considered diabetic. RESULTS: We screened 307 women for GDM by OGCT. Total number of women with positive OGCT was 83 (27.03 %). In the low-risk group, total number of women with GDM was 9/168 (5.35 %) while the total number of women with GDM in the high-risk group was 14/139 (10.07 %). There was no significant difference with respect to the total number of women with GDM in the groups. CONCLUSIONS: A 50 g OGCT seems to be an effective screening test for both groups. More cases of GDM can be discovered when universal rather than risk-related screening is applied.

Early Teenage Pregnancy: Is it Safe?

AIM: To compare obstetric and perinatal outcomes of early and late teenage pregnancies of Omani nulliparous women with singleton pregnancies cared for and delivered at a tertiary teaching hospital. METHOD: In this retrospective study, we reviewed obstetric and perinatal outcomes of early teenage pregnancies (14-16 years), (n = 20) delivered at Sultan Qaboos University Hospital, Muscat, Oman, between 1 July 2006 and 30 June 2013 and compared their outcomes with outcomes of late teenage pregnancies (17-19 years), (n = 287) delivered at the same hospital during same period. RESULTS: When compared with late teenage pregnant women, early teenagers were found to have no significant differences in prevalence of very preterm delivery <32 weeks (P = 0.62), preterm rupture of membranes (P = > 0.99), and anemia (P = 0.34). When compared to late teenagers, early teenagers had similar cesarean sections rates (P = >0.99), instrumental delivery rates (P = 0.56) and spontaneous vaginal delivery rates (P > 0.99). Both groups had similar birth weights (P = 0.87), low birth weights, (P = 0.55), and very low birth weights babies (P = 0.56 %). Perinatal mortality rate was similar in both groups. CONCLUSION: We may conclude that early teenage pregnant Omani women are not at increased risk of obstetric and perinatal complication compared to older teenagers.

Symptomatic Urinary Tract Infection in Diabetic Pregnant Women, Effect of the Type of Diabetes and Glycemic Control.

OBJECTIVES: To compare the prevalence of symptomatic urinary tract infection (S-UTI) in women with gestational diabetes mellitus (GDM), pregestational diabetes mellitus (PGDM), and the effect of glycemic control methods. MATERIALS AND METHODS: This is a retrospective review of women with GDM and PGDM, who had S-UTI treated at Sultan Qaboos University Hospital between January 1, 2009, and December 31, 2010. RESULTS: From a total of 639 women with diabetes mellitus (DM), 91% (n = 581) had GDM and 9% (n = 58) had PGDM. The prevalence of S-UTI was 6.7% (n = 43). The prevalence of S-UTI was 6.5% (n = 38) in women with GDM and 8.6% (n = 5) in women with PGDM. In women with GDM, S-UTI occurred in 4.6% (n = 5) of insulin users compared to 6.9% (n = 33) in noninsulin users. Differences were not statistically significant. CONCLUSION: The prevalence of S-UTI is similar in women with GDM and PGDM regardless of the method used for glycemic control.

Gestational and Pregestational Diabetes Mellitus in Omani Women: Comparison of obstetric and perinatal outcomes.

OBJECTIVES: The aim of this study was to assess the prevalence of gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PGDM) among pregnant women in Oman and compare their obstetric and perinatal outcomes. METHODS: This retrospective study assessed the obstetric and perinatal outcomes of pregnant Omani women with GDM or PGDM who delivered at the Sultan Qaboos University Hospital in Muscat, Oman, between January 2009 and December 2010. RESULTS: There were a total of 5,811 deliveries during the study period. Of the 5,811 women who gave birth, 639 women were found to have diabetes mellitus (11.0%). A total of 581 of the diabetic women had GDM (90.9%) and only 58 (9.1%) had PGDM. Women with PGDM had a significantly higher incidence of pre-eclampsia (P = 0.022), preterm deliveries (P <0.001) and Caesarean sections (P <0.001). Neonatal complications, such as respiratory distress syndrome (RDS), neonatal hypoglycaemia, neonatal jaundice and subsequent admission to a neonatal intensive care unit (NICU) were significantly higher for neonates born to mothers with PGDM compared to those born to mothers with GDM (P <0.001). The corrected perinatal mortality rates for women with PGDM and GDM were 34.5 and 13.7 per 1,000 live births, respectively. CONCLUSION: In this Omani cohort, women with PGDM were at higher risk of developing obstetric and perinatal complications such as pre-eclampsia, preterm delivery and Caesarean delivery compared to women with GDM. In addition, neonates who had mothers with PGDM had higher rates of RDS, neonatal hypoglycaemia, neonatal jaundice and admission to the NICU.

Thrombophilia and Recurrent Pregnancy Loss: Is heparin still the drug of choice?

The association between thrombophilia and recurrent pregnancy loss (RPL) has become an undisputed fact. Thorombophilia creates a hypercoaguable state which leads to arterial and/or venous thrombosis at the site of implantation or in the placental blood vessels. Anticoagulants are an effective treatment against RPL in women with acquired thrombophilia due to antiphospholipid syndrome. The results of the use of anticoagulants for treating RPL in women with inherited thrombophilia (IT) are encouraging, but recently four major multicentre studies have shown that fetal outcomes (determined by live birth rates) may not be as favourable as previously suggested. Although the reported side-effects for anticoagulants are rare and usually reversible, the current recommendation is not to use anticoagulants in women with RPL and IT, or for those with unexplained losses. This review examines the strength of the association between thrombophilia and RPL and whether the use of anticoagulants can improve fetal outcomes.

Obstetric and perinatal outcomes of teenage pregnant women attending a tertiary teaching hospital in oman.

OBJECTIVE: To study the obstetrical and perinatal outcomes of teenage Omani girls with singleton pregnancies at a tertiary teaching hospital. METHODS: This is a retrospective case control study. We reviewed obstetric and perinatal outcomes of teenage nulliparous pregnant Omani girls with singleton pregnancies aged 14 to 19 years, delivered at Sultan Qaboos University Hospital, between 1 July 2006 and 30 June 2013. We compared their outcomes with outcomes of pregnant nulliparous Omani women with singleton pregnancies aged 20 to 25 years old delivered at the same hospital during the same period. RESULTS: When compared with pregnant women (n=307), teenage pregnant girls (n=307) were found to have higher proportion of preterm delivery <32 weeks (7% vs. 3%, p=0.040), preterm pre-labor rupture of membranes (PPROM) (19% vs. 11%, p=0.005) and anemia (58% vs. 44%, p=0.005). Cesarean section rate was higher in women than teenager girls (20% vs. 10%, p=0.001). Teenager girls had lighter babies (mean weight ± standard deviation 2,750±690 vs. 2,890±480, p=0.020), incidence of very low birth weight babies (<1,500g) was higher in teenagers (3.9% vs. 0.3%, p=0.003), but perinatal mortality rate was similar in the two groups. CONCLUSION: Teenage pregnant Omani women are at increased risk of preterm delivery before 32 weeks gestation, PPROM, anemia, and delivering very low birth weight babies.

Fetal weight normograms for singleton pregnancies in a Jordanian population.

BACKGROUND AND OBJECTIVES: Estimated intrauterine fetal weight (EIUFW) is important for reducing prenatal mortality and morbidity through early detection of faltering growth. Our objectives were to develop patterns of ultrasonically determined EIUFW by gestational age, for normal singleton pregnancies, and to assess the effect of a number of variables on EIUFW. METHODS: Ultrasonically, EIUFW was obtained from 600 pregnant women who were at 20 to 42 weeks of gestation (WG). EIUFW was categorized into low weight and normal weight using the tenth and twentieth percentile as the cut-off points. Logistic regression was used to calculate the odds ratio and their 95% confidence limits for a number of risk factors hypothesized to be associated with low fetal weight. EIUFW percentiles (twenty-fifth, fiftieth, and seventy-fifth), by gestational age and sex, were calculated for singleton pregnancies. RESULTS: Up to 32 WG there was no statistically significant difference between male and female fetuses in EIUFW. Between 32 and 39 WG males had significantly (P< .05) higher fetal weight than females. Charts of ultrasonically determined EIUFW by gestational age and sex for singleton pregnancies were created. A number of variables were significantly associated with EIUFW, such as pregnancy weight gain, maternal hemoglobin level, frequency of antenatal visits, smoking status, and fetal sex. CONCLUSION: Weight gain during pregnancy should be encouraged for pregnant mothers who gain less than one kilogram per month in the second and third trimester. A prospective study on a national representative sample in Jordan is needed to generate our own standards for fetal growth.

The outcome of pregnancy in elderly primigravidas.

OBJECTIVE: To investigate the effect of advancing age of 35 years and more (elderly primigravida) on the outcome of pregnancy in nulliparous women and to compare the type of complications observed in this group of women to those in the age of 20-34 years. METHODS: This was a retrospective analysis of 2517 primigravidas delivered at King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia between 1996-2000. All were consecutive patients. The data were collected from the records of the labor room and the medical records were screened for maternal age, antenatal complications, gestational age, birth-weight of the neonate, sex of the neonate and the Apgar score. RESULTS: Three-hundred and sixty-two nulliparous were below the age of 19 years; hence, excluded from the study group. Between age of 20-34 years (Group A) there were 1950 patients with the mean age of 24.79 years (range 20-34) and in women over the age of 35 years (Group B) there were 205 patients with the mean age of 38.72 years (range 35-48 years). Group B had significantly less number of normal deliveries 59.9 compared to group A 81% with p value of <0.001. Diabetes mellitus was common in group B as compared to group A and was statistically significant at p value <0.001. The gestational age in group B was 36.06 weeks and in group A it was 38.84 weeks (p value was markedly significant at <0.001). Women in group B had more deliveries by cesarean section (CS) 23.8% as in group A 12.6%, a significant p value <0.001. The Apgar score at 1 and 5 minutes was significant at p value <0.001 and <0.004. The birth-weight in group B was less compared to group A, p value of <0.002. CONCLUSION: Childbearing in elderly primigravidas does have higher rates of complications due to diseases such as diabetes mellitus and preeclamptic toxemia. They are liable to have more deliveries by CS than by other methods, in spite of lower gestational age and birth weight. The overall outcome however does not appear grim, as was once believed. This study suggests that women in the age group of >35 years should be informed of their pregnancy expectations and outcomes.

Pre-eclampsia: maternal risk factors and perinatal outcome.

OBJECTIVE: The aim of this study was to throw light on the incidence of pre-eclampsia (PE) in women attending for care and delivery at a hospital in Saudi Arabia, and analyze the maternal risk factors and outcome of mothers and neonates in pregnancies complicated by PE. METHODS: This retrospective study involved almost all women (n = 27,787) who delivered at King Fahad Hospital of the University in a 10-year period (1992-2001). The maternal records were reviewed for age, parity, gestational age, mode of delivery, antenatal care, onset of PE, severity of proteinuria, and the frequency of antenatal and intrapartum complications. The neonatal records were reviewed for perinatal outcome including birth weight, frequency of stillbirths, and neonatal deaths. RESULTS: Among the study cohort of pregnancies, 685 women, i.e. 2.47%, were diagnosed as having PE among whom a high proportion (42.0%) were nulliparous women. Similarly, PE was encountered at a high percentage (40.0%) in women at the extreme of their reproductive age (< 20 and >40 years), and more women with PE delivered prematurely (30.2%) as compared to healthy controls (13.5%). Spontaneous vaginal deliveries were less frequent in women with PE (69.2%) as compared with healthy controls (86.2%). Instrumental deliveries, with spontaneous labor, amounted to 15.9% in women with PE, but they comprised only 2.9% in healthy women. The deliveries were more likely to be induced (22.8%) or be performed by cesarean section (14.9%) in women with PE than in healthy controls (6.8% and 9.6%). Placental abruption was the most common maternal complication (12.6%) in women with PE, followed by oligouria (7.9%), coagulopathy (6.0%), and renal failure (4.1%). The perinatal outcome of pregnancies with PE shows that stillbirths (2.34%) and early neonatal deaths (1.02%) comprised an overall mortality rate of 33.6 per 1,000. More stillbirths and neonatal deaths showed a tendency to be associated with the severe form of PE (diastolic BP > or =120), as compared with the mild form (diastolic BP 90-110). Stillbirths and neonatal deaths appear to be associated with women who had no or irregular antenatal care and whose proteinuria amounted to or exceeded 3 g per 24 h, when delivery occurred at 28th gestational week or less, and when the birth-weight of the neonates was between 500 and 1,000 g. CONCLUSION: We document a hospital-based incidence rate of PE of 2.47%, with a high proportion of PE cases occurring among nulliparous women and those at the extreme ends of the reproductive age. More maternal and neonatal complications were encountered in women with PE when the PE was severe, when the pregnancy had to be terminated early, when there was no regular antenatal care, the birth-weight was low, or the proteinuria was severe.

Obstetric and perinatal outcome of women para > or = 5 including one lower segment cesarean section.

OBJECTIVE: To study the prevalence of antenatal, intrapartum and postnatal complications and their perinatal outcome in women who are delivering for the 6th time and have also had one cesarean section. METHODS: The records of all women para > or = 5 with one previous cesarean section (n = 238) delivered at King Fahd Hospital of the University between the January 1 1994 and December 31 2000 were reviewed and compared with women who delivered at the hospital in the year 2000 (n = 2470). This data was analyzed for the peripartum and perinatal outcome. RESULTS: The incidence of malpresentation was higher in the study group. The incidence of uterine rupture and uterine scar dehiscence was significantly higher in the study group, but there was no perinatal or maternal death associated with this and in all cases the uterus was preserved. More women managed to deliver vaginally after the cesarean section in the grandmultiparous women compared with the women in the control group (81.5% vs 63.0%) P < 0.00006, where the cesarean section rate was significantly higher (P < 0.02). There were no significant differences in the incidences of preterm labor, lethal malformations, stillbirths and neonatal deaths in the two groups of women. There was one case of cesarean hysterectomy in each group due to placenta accreta and atonic postpartum hemorrhage, and one maternal death in the control group. CONCLUSION: Grandmultiparous women with one previous cesarean section have an increased risk of operative delivery, scar dehiscence, but there is no increase in perinatal or maternal mortality.

Obstetrics and perinatal outcome of adolescent nulliparous pregnant women.

OBJECTIVE: To study obstetrics and perinatal outcome in nulliparous teenage singleton pregnancies at a referral teaching hospital in the eastern province of Saudi Arabia. METHOD: All singleton births during 1996-2000 of nulliparous mothers aged < or =17 years at King Fahd University Hospital were reviewed (n = 102) and compared with births of a control group of nulliparous mothers aged 20-24 years who delivered during the same period (n = 102). RESULTS: The incidence of nulliparous teenage pregnancies was 0.8%. As compared with women aged 20-24 years, women of 17 years or less were at higher risk of very preterm birth (p < 0.05). The 5-min Apgar scores were not different between the two groups. Babies born to younger mothers had a significantly lower birth weight than those born to older mothers (p < 0.001); the incidence of a low birth weight (<2,500 g) was significantly lower in the control group (p < 0.04). There were no significant differences in distribution of mode of delivery, admission to the special care baby unit, antenatal complications, cesarean section indications, perinatal mortality rate, and early neonatal complications between the two groups. CONCLUSION: The increase in the very preterm births and the subsequently lower birth weight observed in nulliparous teenage women suggest that the maternal age may be a risk factor for very preterm births and associated long-term hazards.

Induction of labor in grand multiparous women and previous cesarean section: is it safe?

OBJECTIVE: To compare the outcome of induced and spontaneous labor in grand multiparous women with one previous lower segment cesarean section, so that the safety of labor induction could be assessed. METHOD: In 56 women labor was induced and their outcomes were compared with those of 177 women with spontaneous labor. All women were multiparous and had had one previous cesarean section. RESULTS: There were no significant differences in the incidences of 1- and 5-min Apgar scores, congenital malformation, cesarean section rates and uterine scar dehiscence or uterine rupture. There were 4 cases of intrauterine fetal death in the induction group, but no case of intrapartum or early neonatal death in the 2 groups. In the study group, 80.4% of the women delivered vaginally compared with 84.3% in the control group. CONCLUSION: In this moderate-sized study, we may conclude that when there is no absolute indication for repeating cesarean section, induction of labor may be a safe option in these high-risk women.